Skills workbook

SKILLS WORKBOOK
A training program
for caregivers, personal
attendants and direct
support professionals.

The Arizona Direct Care Curriculum Project

Skills Workbook

Principles of Caregiving includes the following modules.

• Caregiving Fundamentals (2011)
• Aging and Physical Disabilities Module (2011)
• Developmental Disabilities Module (2011)
• Alzheimer’s Disease and Other Dementias Module (2008)
• Skills Workbook (2011)

Arizona Direct Care Curriculum Project,
Principles of Caregiving.

This material was created for educational purposes by the Arizona Direct Care Curriculum Project. It is
intended as reference material for persons seeking to learn more about this topic. Neither the Arizona
Department of Economic Security and its Division of Aging and Adult Services, nor any individuals or
organizations associated with this project, guarantee that this information is the definitive guide on
this topic, nor does it guarantee that mastery of this material assures that learners will pass any
required examination.

The Principles of Caregiving manuals are posted at www.azdirectcare.org and can be downloaded and
copied.

Cover design and artwork created by Gateway Community College, a Maricopa Community College. All
rights to the logo and cover design are reserved by the Arizona Direct Care Curriculum Project for
exclusive use with the Principles of Caregiving materials and classes.

Current Printing: June 2011

Principles of Caregiving - Skills Workbook 2011 pg. 2

Skills Workbook
Introduction to the Workbook

This workbook was created to complement the Principles of Caregiving curriculum. It covers many of
the skills that are included in the Arizona Direct Care Worker Knowledge and Skills Competencies.
Specifically, it includes the skills that are required or recommended for skills testing. The workbook can
be used to prepare specifically for the skills demonstrations. Please note that the training manuals
(Fundamentals and modules) have additional information about these skills; they also contain
additional skills that may be required for your training. The training manuals are posted on the website
of the Arizona Direct Care Workforce Initiative at www.azdirectcare.org. You can also find the
competencies posted there.

This is still a work in progress; if you have any questions or comments about this workbook, please tell
your instructor or send feedback through the azdirectcare.org website.

Arizona Direct Care Curriculum Project
Revised 2011


Skills Workbook
Acknowledgments

The Principles of Caregiving training manuals were created with guidance from the Arizona Direct Care
Workforce Committee to help establish a high-quality training program for direct care and direct
support professionals in Arizona. Many individuals and agencies were involved, including home care
provider agencies, Area Agencies on Aging, and community colleges. The artwork for the cover was
designed by Gateway Community College. For more information about the curriculum project, please
visit www.azdirectcare.org and the website of the Arizona Department of Economic Security at
www.azdes.gov.

The Direct Care Curriculum Project is a partnership between the Arizona Department of Economic
Security, the Arizona Department of Health Services, the Arizona Health Care Cost Containment
System, the Governor’s Council on Developmental Disabilities, and the Core Curriculum and Expansion
Committee.

The opinions expressed in this material do not represent the official positions of these agencies.


Skills Workbook

Table of Contents
Tips for Demonstrating Skills (Testing) ................................................................................................... 6
Level 1: Fundamentals ........................................................................................................................... 7
Skill: Hand Washing ................................................................................................................................ 8
Skill: Gloving ......................................................................................................................................... 10
Skill: Fire Extinguisher Use .................................................................................................................... 12
Skill: Procedures for Calling 9-1-1 ......................................................................................................... 14
Skill: Procedures for Moving Objects (Body Mechanics for Back Safety) ............................................... 16
Level 2:................................................................................................................................................. 19
Skill: Assistance with Eating .................................................................................................................. 20
Skill: Positioning in Wheelchair............................................................................................................. 22
Skill: Gait Belt Use and Application ....................................................................................................... 24
Skill: Transfer In/Out of Wheelchair ..................................................................................................... 26
Skill: Assist with Ambulation................................................................................................................. 29
Skill: Assist with Dressing ..................................................................................................................... 32
Skill: Assist with Standing from Bed ...................................................................................................... 34
Skill: Assist with Positioning in Bed ....................................................................................................... 36
Skill: Oral Hygiene ................................................................................................................................ 39
Skill: Assist with Positioning on the Bedpan .......................................................................................... 41
Skill: Assist with Bed Bath ..................................................................................................................... 44
Skill: Emptying Catheter Bag................................................................................................................. 47
Skill: Redirect a Person with Dementia ................................................................................................. 49
Tips for the Practice Scenarios.............................................................................................................. 51


Skills Workbook

Tips for Demonstrating Skills (Testing)
The skills described in this workbook should be practiced during training. You should be able to
demonstrate these skills during practice or during a test after training.

General Tips:
• Communication with the client is essential:
o Always explain what you are going to do.
o Always find out if the client has certain preferences.
• Remember that the client has the right to choose the time for an activity or refuse an activity.
• Many common tasks can be activities. Involve the client as much as possible.
• Don’t assume that you should do everything for the client. Always determine how much the
person can do for himself or herself before you help.
• Be sure to offer the client choices or ask what the client would like: Which foods do you like?
What clothes do you want to wear?
• Preserve privacy and dignity for the client.

Test-taking Tips:
• Wear comfortable clothes and solid shoes.
• Be sure to verbalize (explain) anything you cannot demonstrate.
• During practice and testing, act as if you were in a client’s home.
o Act professionally.
o Respect personal property.
o Communicate with the client throughout the procedure.
• If there is a volunteer for the skills demonstration, treat the volunteer with the same courtesy
you would show a client.
• If you have questions about the scenario, ask before you start:
o Does the client have a weak or strong side?
o Is there a choking risk?


Skills Workbook

Level 1: Fundamentals
Hand Washing

Gloving

Fire Extinguisher Use

Procedures for Calling 911

Procedures for Moving Objects (Body Mechanics)


Skills Workbook

Skill: Hand Washing
Competencies:
1. Identify the most effective ways to reduce the spread of infection.
2. List the appropriate times to wash one’s hands.
3. Demonstrate/verbalize proper hand washing techniques.

Supplies:
• Liquid soap (preferred) or bar soap
• Paper towels
• Sink with running water
• Lotion (optional)

Overview
Hand washing is one of the easiest and most effective ways to prevent the spread of infection
when proper techniques are used at the appropriate times when working with clients. It is
imperative that all steps are demonstrated for proper hand washing techniques.
Wash your hands:
• Immediately upon arrival and before leaving a client’s home.
• Immediately if contaminated by blood or any other bodily fluid.
• Before and after contact with a new client.
• Before and after use of gloves.
• After handling soiled linens or waste.
• Before and after contact with any wounds.
• After using the restroom.

 Procedure: Hand Washing
1. Collect items needed for hand washing.
2. Remove all jewelry on hands, fingers, wrists - recommended.
3. Turn on the water and adjust the temperature. Water should be warm but not hot.
4. Wet hands under running water with fingertips pointed down.
5. Apply soap to hands (liquid soap in a pump is best).
6. With fingertips pointing down, lather hands well. Rub your hands together in a circular
motion to generate friction. Wash carefully between fingers, palms, the back of hands and
under/around any jewelry.
7. Rub your fingernails against the palm of the opposite hand to push soap under the nails.
8. Remember: You need to wash your hands a minimum of 20 seconds. (Sing “Happy
Birthday” twice, or “Twinkle-Twinkle Little Star”, to yourself as a timer.)
9. Wash a full hand’s distance up both wrists as well.
10. With fingertips pointed down, rinse off all soap thoroughly.
11. Dry hands with a clean paper towel.
12. Use paper towel to turn off the water and to open the restroom door if needed.
13. Drop paper towel in trash container.


Skills Workbook
Practical Tips
• Use soap – it breaks the surface tension of the water, making the water work harder.
• Friction (rubbing hands together) loosens bacteria and dirt. Remember it is the friction that
kills and loosens the germs, not the soap or water temperature.
• Use plenty of water to wash away the contaminants: dirt, germs and the soap.
• Do not use chemicals such as bleach or alcohol to wash hands. They may damage the skin.
• Do not use a nail brush or any kind of brush. This can damage the skin and cross-
contaminate.
Don’t forget!
• You must wash your hands for at least 20 seconds for effective decontamination.
• Keep fingers pointed down into the sink. Do not allow water to run up the arm, off the
elbows.
• Don’t forget to wash the wrists.
• Either remove jewelry or wash under items. Germs hide under rings and bracelets.
• Don’t touch the faucet, sink, surfaces, or doorknobs with hands after washing. This will re-
contaminate your clean hands.

! Remember: Intact skin is your best defense
against bacteria. Treat your hands well!

The following checklist will be used in the evaluation of the demonstration.

Skill: Demonstration of Proper Hand Washing Skills Comments
• Verbalizes/demonstrates proper procedure-all steps.
• Verbalizes when hand washing is necessary.
• Demonstrates/Verbalizes avoidance of cross
contamination.


Skills Workbook

Skill: Gloving
Competencies:
1. Give examples of how germs are spread.
2. Give examples of when gloves should be worn.
3. Demonstrate/verbalize how to apply, remove and dispose of gloves.

Supplies:
• Well fitting gloves
• Paper towel, soap and water for hand washing

Overview
Personal Protective Equipment (PPE), such as disposable gloves, allows you to create a barrier between
yourself and germs. By using disposable gloves you are preventing the spread of infectious diseases like
the common cold, the flu, MRSA or HIV, just to name a few. Wearing gloves is not just for your
protection but the protection of others as well.

Disposable gloves should be worn when:
• Touching blood or body fluids.
• You or the individual you are caring for has cuts, sores or other skin openings.
• There is possible contact with feces, urine, vomit or wound drainage.
• Handling soiled clothing or linens.
• Cleaning the bathrooms.

 Procedure: Putting on Gloves
1. Wash and dry your hands following proper procedures.
2. Remove a pair of gloves from the glove box.
3. Use care when pulling gloves on. If a glove tears or becomes punctured take it off and start
again with a new glove.
4. Interlace fingers to remove wrinkles, air pockets and achieve a comfortable fit.
5. You may want to consider double gloving if your nails are longer and at risk of puncturing the
gloves or if they will become heavily soiled. Double gloving simply means wearing two pairs of
gloves.


Skills Workbook

 Procedure: Removing and Disposing of Gloves
1. From the outside, pinch the rubber glove just below the cuff using your thumb and index finger
to lift the glove away from your wrist area.
2. Using your middle and ring fingers, scoop the glove away from the wrist; pulling it off inside
out. Ball that glove tightly into palm of gloved hand.
3. Now with ungloved hand slide your index and middle finger under the cuff of the other glove;
again pulling it off inside out. The first glove you removed should now be inside the second
glove.
4. Follow your agency’s policies in disposing of the gloves.
5. Wash your hands following proper procedure.

Practical Tips:
• Disposable gloves should NEVER be washed or re-used.
• Always replace if they become ripped, torn or contaminated.
• Always wash hands before and after.
• Know your agency’s policies on disposing of gloves. Policies may differ between agencies.
• Wear gloves that fit properly. If they are the wrong size, they can tear or fall off.

Don’t forget!
• Contamination can happen when:
o touching unclean areas (the wrist, other surfaces)
o placing gloves on contaminated surfaces or in your pocket
• removing gloves
• You must wash hands when you replace gloves
• Long nails can puncture gloves

General rule: Touch the outside of a glove only with a glove.


Skill: Gloving Comments
• Verbalizes/demonstrates proper procedure-all
steps.
• Verbalizes when hand washing is necessary.
• Demonstrates/Verbalizes avoidance of cross
contamination.


Skills Workbook

Skill: Fire Extinguisher Use
Competencies:
1. Identify common emergency situations.
2. Describe fire safety techniques and risk factors.
3. Identify potential fire hazards in the home: frayed cords, open flames, cigarette smoking.
4. Describe or simulate the use of a fire extinguisher.

Supplies:
• Fire extinguisher

Overview
A fire needs 3 elements – oxygen, heat and fuel. To extinguish a fire you need only take one of these
elements away. That is the purpose of a fire extinguisher: If used properly, a fire extinguisher will
remove one or more of the elements needed by the fire.

Description of Procedure:
1. Ensure client is safe and free from possible injury/smoke damage.
2. Determine if the fire is fightable.
3. Do not fight the fire if:
• The fire is spreading
• The type or size of the extinguisher is wrong
• The fire is too large
• If you do not know how to use a fire extinguisher
4. Retrieve the fire extinguisher.
5. Use the P.A.S.S. acronym:
• Pull the pin from the handle area at the top of the Fire Extinguisher and remove the hose
from the clamp (if applicable).
• Aim the hose nozzle at the base of the fire. (You should be at least 10 ft. from the fire.)
• Squeeze the lever in order to release the chemical.
• Sweep the hose nozzle from side to side at the base of the fire. (You will only have about 10
seconds of extinguishing power.)

Practical Tips:
• Know the location of the fire extinguisher.
• Know the type of fire extinguisher to use (ABC puts out most classes of fire).
• Check to see if the fire extinguisher is fully charged.
• Remember the extinguisher is heavy and only blasts for a few seconds.
• Stand at least 10 feet from the fire.
• Aim the spray of the extinguisher at the base of the fire. Aiming high spreads the fire.


Skills Workbook
Don’t forget!
• Use the P-A-S-S acronym.

• Don’t forget the client. Where is the client? Is the client safe and free from smoke contact?
Do you need to assist or rescue the client?

Most fire extinguishers operate using the following P.A.S.S. technique:

1. PULL... Pull the pin. This will also break the
tamper seal.
2. AIM... Aim low, pointing the extinguisher nozzle
(or its horn or hose) at the base of the fire.

Note: Do not touch the plastic discharge horn on
CO2 extinguishers, it gets very cold and may
damage skin.
3. SQUEEZE... Squeeze the handle to release the
extinguishing agent.
4. SWEEP... Sweep from side to side at the base of
the fire until it appears to be out. Watch the
area. If the fire re-ignites, repeat steps 2 - 4.

If you have the slightest doubt about your
ability to fight a fire....EVACUATE
IMMEDIATELY!
Source: United States Department of Labor, www.osha.gov/SLTC/etools/evacuation/portable_use.html

Resources:
http://www.emd.wa.gov/preparedness/videos/video_using_a_fire_extinguisher.shtml
http://www.hanford.gov/fire/safety/extingrs.htm


Skill: Proper Use of Fire Extinguisher Comments
• Verbalizes/demonstrates proper procedure.
• Ensures client’s safety.
• Demonstrates/Verbalizes PASS acronym.
• Demonstrates proper safety points in using
fire extinguisher.


Skills Workbook

Skill: Procedures for Calling 9-1-1
Overview:
Emergency situations can be very stressful for everyone involved. It is important that you remain as
calm as possible to get the necessary help as quickly as possible. Individuals with disabilities and those
who are elderly are more vulnerable to injuring themselves in their home environments or becoming
seriously ill, requiring immediate medical attention. It is very possible a situation may arise where the
DCW will be required to place an emergency 9-1-1 call.

Some situations that would require you to call 9-1-1 would be:
• Chest pain
• Shortness of breath
• Suspected heart attack or stroke
• Suspected heat stroke
• Non-responsiveness
• Confusion that is not common with individual
• Individual falls and cannot get up
• Fire
• Safety issues, such as gas leaks

Competencies:
1. Identify common emergency situations.
2. Explain general guidelines for emergencies, including when to call 9-1-1.
3. Describe the proper procedure for calling 9-1-1.

Supplies:
• Land line phone (preferred over cell phone)

1. Stay calm. – The calmer you remain, the quicker you will be able to get help. Take a deep breath
and proceed.
2. Assess the client for responsiveness. Ensure the client is safe in the environment.
3. Call 9-1-1 preferably from a land line phone.
4. State the nature of the emergency in plain, concise tone.
5. State the location of the emergency with the nearest cross streets.
6. Give your name and telephone number.
7. Remain on the line until dispatch tells you to hang up.
8. Render first aid as needed to the client.
9. Stay alert to your surroundings, staying with client, rendering assistance. Reassure and calm the
client until the emergency medical services (EMS) team arrives.
10. Notify your supervisor as soon as possible.


Skills Workbook

Practical Tips:
• Remain calm.
• Call from a land line. There are fewer dropped calls, and some emergency systems cannot
locate you when you use a cell phone.
• Have someone else call if possible. Remain focused on client and his/her needs.
• Render appropriate care for the conditions you find, within the scope of your training.
• Stay with the client until transported and explain what is happening.
• Know agency’s policy for reporting emergency situations.
• Be available to answer questions from the emergency response system (EMS) team.

Don’t forget!
• Do not leave the client unattended for a long period. Be sure to render assistance to the client
while waiting for EMS.
• Remember to communicate to the client throughout.
• Know the full address where you are. Response time is longer if EMS has to search for the
location.

Practice Scenarios:
1. You are at a client’s home and he becomes non-responsive. Upon checking, he is not breathing,
no heartbeat is detected, and he remains slumped over in his chair. What do you do?

2. You are assisting your client with ambulation when she trips over her dog. The client falls to the
floor. The client has a lot of pain in her right hip region and is not able to get up on her own.
After getting her as comfortable as you can, what will you need to do?


Skill: Calling 911 Comments
• Verbalizes correct procedures for calling 9-1-1.
• Verbalizes assistance / first aid to client.
• Verbalizes the advantage of calling from a
land-line vs. a cell phone.


Skills Workbook

Skill: Procedures for Moving Objects
(Body Mechanics for Back Safety)
Overview
Just as lifting, pushing, and pulling loads can damage your back, so can bending or reaching while
working. It is important for a DCW to know how to interact with the environment to reduce the risk of
injury. Common situations involved in the DCW’s daily routine can be picking up items, carrying
groceries, and moving objects from one place to another.

Competencies:
1. Explain the importance of good body mechanics and lifting techniques.
2. Describe elements of good body mechanics, such as proper use of leg muscles and keeping
center of gravity over the base of support.
3. Describe and demonstrate proper technique for moving objects with good body alignment.

Supplies:
• 10 pound bag potatoes
• 10 pound box

1. Start with good standing position; feet are shoulder width apart.
2. Keep knees bent slightly.
3. Keep your center of gravity (which is usually right behind a person’s belly button) over base of
support (which is the proper stance the person is in).
4. Squat with the chest and buttocks sticking out. This position will keep your back flat.
5. When you squat down or squat back up, place your elbow or hand on your thigh or the counter
to take some pressure off your back.
6. Use leg and upper body muscles when elevating/lowering an object, keeping body in alignment
(keep your buttocks behind you - no twisting). Utilize the whole body to complete the task.
7. Keep object close to body (10-pound weight at arms length will put 150 pounds of pressure on
your back).


Skills Workbook
Illustration: When holding, lifting or carrying items
Before lifting boxes and cases, check to see if the weight is given so you can prepare to lift
properly.
Keep the item close to your body.
Turn with the feet, not the torso.
Keep your back straight.
Use your legs to do the lifting.
Get close to where you want to set the item down.

Source: United States Department of Labor,
http://osha.gov/ergonomics/guidelines/grocerysolutions/index.html

Practical Tips:
• Maintain good stance – be aware of your center of gravity over base of support.
• Keep object close to you.
• Keep your bottom behind the activity! Don’t twist from side to side.
• Bend your knees. Lift with your legs (not with the back). Squat with your back in neutral
position.
• Don’t lift objects that are too heavy.
• Use a stool or ladder to retrieve items above your head.
• Think before you do. Mentally plan and practice your task.
• Maintain your natural spinal curves. Maintain neutral posture when you are sitting, standing,
lifting, pushing or pulling.
• Pivot, don’t twist. Turn your feet rather than twist your body.


Skills Workbook
Don’t forget!
• Keeping your feet too close together results in poor leverage; you may lose your balance.
• Rounded back results in stress on the back.
• Twisting your upper body can result in a strained back.
• Carry items close to your body.

Practice Scenario:
The client received a medium package weighing about 15 lbs. in the mail and the delivery person left it
on the front porch. The DCW was asked to bring the package inside. Demonstrate/verbalize the proper
lifting procedure to bring this package inside.


Skill: Moving objects Comments
• Demonstrates proper stance when lifting.
• Demonstrates good body mechanics when
lifting.
• Does not twist spine.
• Lifts with legs, not back.
• Holds objects close to body when carrying
them.


Skills Workbook

Level 2:
Aging and Physical Disabilities
Developmental Disabilities

Assistance with Eating
Positioning in Wheelchair
Gait Belt Use and Application
Positioning in Wheelchair
Transfer in/our of Wheelchair
Assist with Ambulation
Assist with Dressing
Assist with Standing from Bed
Assist with Positioning in Bed
Redirect a Person

Aging and Physical Disabilities
Assist with Positioning of Bedpan
Assist with Bed bath
Emptying Catheter Bag

Developmental Disabilities
Assist with Oral Hygiene


Skills Workbook

Skill: Assistance with Eating
Overview
Providing assistance with eating and/or feeding a consumer is a skill that many Direct Care Workers
will use on a daily basis. The purpose of this skill is to ensure that the DCW knows the correct
technique for assisting with and/or feeding another individual.

Competencies:
1. Identify and explain the relationship between a person’s service plan and the DCW role when
providing assistance with activities of daily living.
2. Be aware of assistive devices available and their uses as feeding aides.
3. Give examples of techniques that can be used to promote independence and respect a person’s
preferences.
4. Demonstrate/verbalize the procedure for assisting a client with eating.

Supplies:
• Spoon and/or fork, napkin, bowl or plate, clothing protector, cup.
• Food items

1. Maintain dignity and safety of client at all times.
2. Check care plan or with supervisor to determine if choking hazard exists.
3. Ensure that you cut up meat, open cartons, butter bread, etc. if that type of assistance is
needed.
4. Sit next to the individual at eye level.
5. Ensure that the individual is sitting with his/her head elevated to prevent choking.
6. Provide ONLY the amount of assistance that is necessary (graduated guidance, hand over hand,
etc). Encourage the client to be as independent as possible.
7. Check the temperature of food before you begin feeding. Feel the container, observe for steam,
to ensure the food is at an acceptable temperature.
8. Explain what foods are on the plate. For someone with a visual impairment, use the clock
description method (e.g., “Your meat is at 12:00, vegetables are at 3:00,” etc.).
9. Ask the individual what he/she wants to eat first.
10. Watch the individual to make sure food is swallowed before giving additional food or fluids.
Remind the individual to chew and swallow as necessary.
11. Offer liquids at regular intervals.
12. Engage the client in pleasant conversation while completing this task, but don’t ask questions
that take too long to answer.
13. Do not rush the individual.
14. Once the meal is complete, ensure that you help the individual in wiping his/her face and
washing hands as necessary.


Skills Workbook
Practical Tips:
• Be aware of how the individual may be feeling in regards to needing assistance. Ensure dignity
and respect by allowing clients to make their own food choices, giving options and respecting
preferences.
• Be aware of any issues causing the individual to tire out or get frustrated easily.
• Pay special attention to individuals who may present a choking hazard.
• Ensure that you are communicating with the individual about the pace in which you are feeding
or assisting him/her with eating.

Don’t forget!
• Don’t do everything for the client just because it is faster for you. Only provide the assistance
that is truly needed.
• Don’t assume the individual likes every item that has been served.
• Don’t treat the client like a child. For example, do not wipe client’s mouth with the spoon.
• Serve food in proper consistency to avoid choking.

Right way Wrong way

Practice Scenarios:
1. Jenny is 26, is visually impaired and lives in an assisted living facility. Jenny is capable of feeding
herself, but requires some basic assistance during meal time.

2. Marilyn is a 70 year old woman. Marilyn has had two strokes, which has left her with weakness
on her right side. Marilyn has very limited use of her right hand. Marilyn is going to have lunch
before going shopping for the afternoon.


Skill: Assistance with Eating Comments
• Communicates effectively with client
regarding preferences and choices.
• Describes the order of the food on the plate
and the location of drink using the clock
method.
• Assists only at level needed and requested to
maintain independence.
• Questions evaluator as to presence of choking
risk.

Skills Workbook

Skill: Positioning in Wheelchair
Overview
When a person with a disability is sitting in a wheelchair or chair, make sure she/he is sitting upright to
prevent the risk of contractures and pressure sores (ulcers). A proper sitting position places the person
in good, comfortable alignment. Good alignment involves head, shoulders, hips squarely over the axle
of the wheel.

Competencies:
1. Explain the importance of repositioning and list techniques to prevent skin damage.
2. Identify common causes for skin breakdown for persons in a wheelchair.
3. Demonstrate technique for re-positioning a person in a wheelchair.
Position of front wheels
1. Explain to the client what steps you are going to do to
reposition him.
2. Have wheel chair locked with caster wheels in forward
position. This can be accomplished by moving the
wheelchair backwards. Then the front caster wheels
swivel forward, which gives the wheelchair a better base
of support. Incorrect Correct
3. Swing foot rest to side, or remove if possible.
4. Stand in front of the person with the left leg of the person between your legs.
5. Have the client lean forward with the person putting his/her head above your left hip. This
places most of the person’s weight on his/her right buttock side. Your left arm should come
across the person’s back to provide stability.
6. Place your right arm under the thigh of the
person’s left leg while placing slight pressure
against the person’s left knee with your knee.
It is best to use the wide area above your
knee to press against the client’s knee.
7. With a fluid motion, use your entire body to
gently push the person toward the back part
of the wheelchair.
8. Let the client sit up, and then repeat the
same procedure for the other side of the
person.
9. You might need to do this several times (both left side and right side) for the correct alignment
of the client in the wheelchair.

Practical Tips:
• Always explain to the person what is being done.
• Make sure wheels are locked.


Skills Workbook
• Make sure the person’s weight is on the side opposite the side that is to be re-positioned.
• Use your entire body when positioning.
• Prepare for this technique by repositioning yourself in a chair: Sit on the edge of a chair (or
slouch). Then move yourself backward without using your hands. This motion of backing up in a
chair (first one side, then the other) is used for the technique of repositioning.

Don’t forget!
• Always use proper body mechanics. Poor body mechanics can injure both you and the client.
• Do not rush the procedure; you may need to do this procedure a couple of times to get the
client all the way back in the chair.
• DO NOT lift client over the back of the handles of the wheelchair

Practice Scenarios:
1. John, who is quadriplegic and uses a mechanical lift to be transferred into the wheelchair,
regularly needs to be repositioned in the wheelchair to have a good sitting alignment.
Demonstrate how you would reposition John if he is sliding out of the wheelchair.

2. Aunt Mabel is very small in stature. Aunt Mabel just loves to sit in the reclining chair to watch
TV. This repositioning procedure will assist Mabel to be able to sit to the back of the reclining
chair.


Skill: Repositioning in Wheelchair Comments
• Demonstrates ability to maintain proper body
alignment of client and DCW.
• Displays proper safety procedures: locking
wheelchair, wheel alignment, body mechanics.
• Adequately demonstrates/verbalizes proper
step by step procedure for skill as described.
• Communicates procedure and expectations
with client.
• Verbalizes/Identifies all main points from the
scenario given.


Skills Workbook

Skill: Gait Belt Use and Application
Overview
A gait belt provides the Direct Care Worker with a secure point to hold while assisting clients in walking
and transfer activities. It is also called transfer belt.

Special Note:
Ensure the client can safely wear a gait belt. You may not be able to use one if the person:
• Has had recent surgery or incisions (within the last 6-8 weeks) in the abdominal and back areas.
• Has an ostomy (e.g. a colostomy), G-tube, hernias, severe COPD, post-surgical incisions,
monitoring equipment, tubes or lines that could be interfered with by the pressure.
• Is pregnant. Applying a gait belt to a pregnant woman could cause injury to the unborn child.

If the DCW determines the client cannot safely use a gait belt, the DCW should contact the
supervisor for instruction on agency specific policy and procedures.

Competencies:
1. Identify and describe common assistive devices including a gait belt.
2. Explain the importance of proper transfer skills and the safe use of assistive devices.
3. Describe/role-play the procedure for application and use of a gait belt.

Supplies:
• Gait Belt (with metal teeth or quick release buckle)


1. Tell the person what you are going to do.
2. Position the person to make application of the belt easier. Have the
person move forward and sit on the edge of the chair.
3. Place the gait belt around the client’s waist, above the pelvic bone
and below the rib cage. Always place the gait belt on top of
clothing, and for females make sure breast tissue is above the belt.
4. Pass the metal tip of the belt end through the teeth of the buckle
first and then through the other side of the buckle.
5. Adjust it so it is snug, but not uncomfortable for the client. You
should be able to slip your open flat hand between the belt and the
client.
6. Tuck the excess end of the belt through the waist band.
7. The strap should lay flat across the buckle.
8. ALWAYS verify proper closure before use.
9. ALWAYS grasp the transfer belt from underneath.
10. Remove the gait belt when not in use, or loosen it.


Skills Workbook

Practical Tips:
• It is important that you ask permission before applying a gait belt because you are about to
invade the client’s personal space. Maintain client’s rights by informing him/her of all
procedures prior to actions.
• Gait belts come in various lengths; use an appropriate size for the client.
• Belts with padded handles are easier to grip and increase security and control.
• Use a rocking and pulling motion rather than lifting when using a belt.
• DCW should walk slightly behind the client with a hand under the bottom of the belt.
• On some gait belts, the seam and label will be on the outside, on other belts it is on the inside.
Don’t assume that the manufacturer’s label is on the inside – be sure to start putting the end of
the belt through the teeth first.

Don’t forget!
• Apply gait belt over clothing, NEVER apply to bare skin.
• Check female clients to assure no breast tissue is caught in belt.
• Use good body mechanics when transferring a client with a gait belt.


Skill: Gait belt Use and Application Comments
• Communicates well with person regarding
expectations of procedure.
• Demonstrates ability to put on gait belt
correctly.
• Verbalizes procedure pitfalls and safety
requirements.


Skills Workbook

Skill: Transfer In/Out of Wheelchair
Overview
A move as basic as getting in and out of a chair can be difficult for an individual with a disability.
Techniques for assisting an individual with transfers can vary from minimum assist to maximum assist.
While procedures can vary for certain kinds of transfers, there are general guidelines that apply when
assisting with any transfer.

Competencies:
1. Identify and describe common assistive devices including gait belts and wheelchairs.
3. Demonstrate the proper technique for transferring someone in/out of a wheelchair.

Supplies:
• Wheelchair, chair
• Gait belt
Note: Person is 50% or more weight bearing (moderate assist)
1. Ensure the client can safely wear a gait belt. (See procedure for gait belt application.)
2. Explain the gait belt procedure to the client.
3. Ask the client’s permission to use the gait belt. Explain the belt is a safety device and will be
removed as soon as the transfer is complete.
4. Tell the client what you are going to do.
5. Lock the wheels of wheelchair.
6. Put the footrest in the up position and swing the footrest to the side or remove.
7. Take off the armrest closest to the chair (or drop armrest, if possible).
8. Place chair at a 45 degree angle to the wheelchair.
9. Have the client move to the front of wheelchair seat.
10. Use gait belt secured around client’s waist to assist him/her out of the wheelchair.
11. Foot placement (depending on the client’s disability or preference):
a. Place both of your feet in front of the client’s fee with toes pointing outward
b. Place one foot slightly in front of the other one. This foot in front will be placed
between the client’s feet.

12. Have the client either hold onto your shoulders or arms, not around your neck!


Skills Workbook
13. Grasp the gait belt on both sides with fingers under belt.
14. Bend at knees and hips. Using your body leverage lift with legs, not back.
15. Assist the client to a standing position, mirroring posture of person.
16. Have the client stand for a minute, shifting weight from one foot to other.
17. Pick up your feet and move them, facing the chair as the client takes baby steps to a standing
position in front of chair.
18. Ask the client if he/she feels the chair seat on the back of his/her legs.
19. Have the client put his/her hands on the armrests.
20. Assist the client to a seated position, mirroring their posture.

Practical Tips:
• DCW should always wear proper foot wear (closed, non-slip, flat shoe).
• Use smooth fluid motion.
• Don’t rush the transfer procedure.
• Don’t transfer a person who is too heavy for this type of body transfer. Ask your supervisor for
further training.

Don’t forget!
• Keep body in proper alignment; use proper body mechanics.
• Move feet with the pivot, do not twist.
• Be sure to place gait belt properly.

! At no time should the client put her / his hands around the DCW’s neck
during a transfer. Serious injury can occur.

Practice Scenarios:

1. The Direct Care Worker is in process of transferring the client from wheelchair to an armed
chair and the client insists that the DCW allow him to put his arms around the DCW’s neck
because this gives the person balance. What should the DCW do?

2. The DCW has been called into work for an emergency relief position and just left a dance recital
wearing high heels. She arrives at the client’s home and realizes the person needs to be
transferred from the wheelchair to the commode. She has the skill to perform this task. What
should she do?


Skills Workbook

Skill: Transfer In/Out of Wheelchair Comments
• Communicates with person.
• Demonstrates good body mechanics when
transferring a person from wheelchair to chair.
• Does not twist spine.
• Body leverage with legs, not back.
• Moves feet the same direction the person is
being transferred to.
• Demonstrates ability to position wheelchair,
footrests and brakes correctly.


Skills Workbook

Skill: Assist with Ambulation
Overview:
Ambulation simply means to walk or move from one place to another. Every client will be different in
his or her level of need for assistance, and it will differ in how you help each one. We have heard the
old saying that there are no two people alike. There are also no two disabilities that are alike. The
question becomes how do we do this when the individual we are assisting cannot do it on his/her
own?

There are several benefits to ambulation, some of which include:
• Relieve stress and anxiety
• Improve and/or maintain muscle strength
• Improve circulation
• Decrease digestion and elimination problems
• Improve appetite

Competencies:
1. Identify and describe common assistive devices including gait belt.
3. Describe and role-play techniques to assist with ambulation/use of gait belt.
4. Identify the characteristics of clients who may be at risk for falls during ambulation.

Supplies:
• Gait Belt and/or other walking aids like a cane or a walker
• Non-slip, properly fitting footwear


Skills Workbook

Ambulation:
1. Before you begin, familiarize yourself with the expectations and
requirements of the service plan. Contact your supervisor for
clarification.
2. Ensure the client can safely wear a gait belt. See “application of gait
belt” for procedure and contraindications.
3. Communicate procedure to client before you begin.
4. Apply non-skid, properly fitting footwear.
5. Have the client’s walking aid readily available if required.
6. Apply gait belt (see procedure for gait belt application).

7. Make sure that the client has his feet firmly on the floor.
8. Use an underhand grasp on the belt for greater safety.
9. Assist client to a standing position as described in other skills
(e.g. Transfer out of wheelchair).
10. Walk behind and to one side of the client during ambulation. Hold
on to the belt from directly behind him. Be aware to support weaker side if applicable.
a. Right side: you should be standing between 4 and 5 o’clock.
b. Left side: you should be standing between 7 and 8 o’clock.
11. Let the client set the pace, and walk in step with the client, maintaining a firm grasp on gait
belt.
12. Watch for signs of fatigue.

Ambulation with a Cane:
The handle of the cane should be at a height that would be equivalent to where the client’s wrist of his
strong hand would fall if his hand was placed at his side when standing in an upright position. The
client should be using the cane on his strong side, and the DCW should be walking on his weak side for
assistance.

Ambulation with a Walker:
When assisting a client with ambulation when using a walker, it is important
that the client stay inside the frame of the walker. Make sure it has been
properly fitted for the individual. The DCW should always walk on the client’s
weak side to provide additional support as needed.

Special Note:
In the instance a client does collapse or loses his/her footing, it is acceptable to
ease the person gently to the floor. The DCW should not try to carry the
person, hold him up or catch him if he starts to fall.


Skills Workbook
Practical Tips:
• Communicate expectations with the client at all times.
• Encourage the client to assist as much as possible.
• Be aware of, and remove, tripping hazards: electrical cords, throw rugs, clutter.
• Make sure that you are standing on the consumer’s weak side, if applicable.
• Be observant: the client may tire easily and can only handle short walks.
• Ensure assistive devices fit properly; notify your supervisor with concerns.
• The tips on the canes wear out over time and it may be necessary for them to be replaced
periodically.
• Don’t rush the client to meet your schedule.

Don’t forget!
• Keep a firm grasp on gait belt.
• Don’t assume that once the client is up and moving, he/she will continue to be stable. Always
be prepared for a fall.

Practice Scenario:
The client has experienced a stroke and has right side weakness. He uses a quad cane. He will need
assistance standing up and is not always confident he can make it from the living room to the
bathroom by himself. Please demonstrate how the DCW would assist him with ambulation.

Resource: http://www.youtube.com/watch?v=386tpXsaXI4


Skill: Assist with Ambulation Comments
• Communicates with client before and during
procedure.
• Demonstrates safe transfer using gait belt and
correct body mechanics.
• Demonstrates correct hand position when using
gait belt.
• Demonstrates correct position when assisting
with ambulation.
• The Applicant is able to verbalize the listed
procedures if requested.


Skills Workbook

Skill: Assist with Dressing
Overview
Providing assistance with dressing, or dressing a client with or without an extremity weakness, is a skill
that many Direct Care Workers will use on a daily basis. The purpose of this skill is to ensure that Direct
Care Workers know the correct technique for assisting and/or dressing another individual. As with
other tasks, it is important that the DCW allows the client to be as independent as possible, even if
the person dresses slowly.

Competencies:
2. Describe / role-play assistance with dressing a client, with or without specific weaknesses.

Supplies:
• Article of clothing client wishes to wear

1. Communicate with client the assistance procedure and expectations.
2. Provide for client’s comfort and privacy.
3. Discuss client’s preference of clothing. Offer the client a choice of what they want to wear that
day.
4. Retrieve the clothing, and lay it out in an orderly fashion.
5. Dress weak side first (if applicable). Put the clothes on the weaker arm and shoulder side first,
then slide the garment onto the stronger side. When UNDRESSING, undress the strong side
first.
6. As much as possible, dress the client seated. Put on underwear and slacks only up to the client’s
thighs. To finish, ask him/her to stand, or assist to stand, and then pull up the underwear and
slacks.
7. Continue to communicate each step in the process as you go along.

Practical Tips:
• Always discuss with clients what their preferences are and how they are most comfortable.
• Don’t assume a client wants to wear items of clothing that someone else may have chosen for
them.
• Be aware of how the client may be feeling in regards to needing assistance.
• Be aware of any issues that could cause the client to get tired or frustrated easily.
• Be pleasant while completing this task, engage the client in conversation.
• Encourage the client to wear clothes with elastic waistbands and Velcro closures.


Skills Workbook
Don’t forget!
• Encourage the client to be as independent as possible.
• Only provide the assistance needed – don’t do everything for the client just because it is faster
for you.
• If the person has a stronger and a weaker side, put the clothes on the weaker arm and shoulder
first. Then slide the garments on the stronger side. When undressing, undress the strong side
first.

Practice Scenario 1:
Helga is 30 and lives at home with her mother. Helga has a brain injury from a car accident. Helga has a
doctor’s appointment, and the van will be at the home in 30 minutes to pick her up. Assist Helga in
getting dressed for her doctor’s appointment, using proper techniques and procedures.

Practice Scenario 2:
John is a 40 year old man, who does not communicate with speech. John uses gestures and facial
expressions to communicate his wants and/or needs. John’s son is coming to take him out to dinner at
Red Lobster. Assist John in getting dressed for dinner.


Skill: Assist with Dressing Comments
• Asks client for clothing preferences.
• Maintains client privacy and safety.
• Dresses client in correct order weak/strong
side.
• Knows amount of assistance needed and
provides only the level of assistance necessary.


Skills Workbook

Skill: Assist with Standing from Bed
Overview
The DCW’s main focus is to be as helpful as possible, assisting clients with their activities of daily living
as needed. There are times when just a little assistance is needed, for example, assisting a client from
the bed to a standing position.

Competencies:
1. Explain the importance of proper transfer skills.
2. Identify the characteristics of clients who may be at risk for falls during ambulation.
3. Explain the importance of good body mechanics and transfer techniques.
4. Describe/demonstrate the techniques for rendering standing assistance from a prone position.

Supplies:
• Non-slip shoes/socks

1. Tell the client what you are planning to do.
2. If the person is in a hospital bed:
a. Raise the head of the bed.
b. Assist in having the person extend his/her legs over the edge of the bed.
c. Support the person’s back and shoulders (not the neck) if needed, and help him/her to a
sitting position.
3. If the person is in a standard bed:
a. Have the client roll onto his side, facing you, elbows bent, knees flexed.
b. Assist in having the person extend his/her legs over the edge of the bed.
c. Instruct client to use his/her forearm to rise up and the opposite hand to push up to a
sitting position while you support his back and shoulders (not the neck) if needed.
d. You may also need to place your arm under the person’s knees and help him/her to a
sitting position.
4. Allow client to sit on the edge of the bed for a minute or two to regain a sense of balance. Make
sure the person does not slip off the edge of the bed.
5. Assist with putting on non-skid footwear (sneakers, slippers, tread socks are good choices).
6. If bed was raised or lowered, make sure to adjust to a height in which the client’s feet can
touch the floor comfortably.
7. Instruct client to place feet flat on the floor.
8. Ensure the client is oriented and stable before assisting to stand.
9. Keep one hand on the client’s elbow and the other behind the client’s back when standing.


Skills Workbook
Practical Tips:
• Be sure to have supplies ready. Do not leave client on the edge of the bed while you go find
slippers or a robe.
• Remember to support limbs and back during procedure.
• BE OBSERVANT! It is common for the blood pressure to drop when going from a prone to a
sitting position, causing light-headedness or dizziness. Watch the client for changes in
condition, such as color change, respiratory changes, and other signs of distress.
• Use good body mechanics when turning and rolling, moving, standing. Protect your back.
• Encourage the client to help as much as he possibly can; this helps maintain independence.

Don’t forget!
• Don’t forget to lower the bed if a mechanical bed is being used.
• Do not pull client by arms, hands, wrists etc. Support back and knees to prevent injury.
• Do not place your hands/arms around the client’s neck when assisting.
• Do not let the client place his hands/arms around your neck while you assist.

Practice Scenario:
Mrs. Anderson is 82 years old and lives by herself, with family living on the next street. She has arthritis
in both hips and does not ambulate well. She has had three falls in the past months. A recent bout of
pneumonia has left her physically weaker than normal and she prefers to be out of bed for only short
periods of time. With encouragement and instruction, Mrs. Anderson can and will roll on her own and
assist with sitting. She can ambulate with her walker for short distances, to the bathroom or her
recliner. Mrs. Anderson likes to get up and sit in her chair while the DCW makes her bed or changes
the linen.

Please demonstrate the actions necessary to help Mrs. Anderson stand beside her bed.


Skill: Assist With Standing from Bed Comments
• Communicates with the client before and
during procedure.
• Ensures client’s privacy/safety.
• Demonstrates correct procedures in assisting
client to stand from a prone position.
• Demonstrates proper body mechanics during
demonstration.
• Demonstrates proper safety points in standing
client.
• The candidate is able to verbalize the listed
procedures.


Skills Workbook

Skill: Assist with Positioning in Bed
Overview
Proper alignment of a client while in bed can be essential to the person’s comfort and proper rest. The
DCW must conscientiously assist in maintaining good body alignment, proactively address pressure
points, and support the natural curves of the body. These curves need to be supported to prevent
undesired pressure that may lead to uncomfortable areas or pressure sores.

Proper positioning:
• Helps the client feel more comfortable.
• Relieves strain.
• Helps the body function more efficiently.
• Prevents complications with skin breakdown and pressure sores.

Competencies:
1. Explain the importance of re-positioning and list techniques for preventing skin damage and
pressure sores.
2. Identify the characteristics of clients who may be at risk for skin integrity concerns.
3. Identify common causes of skin breakdown.
4. Describe/demonstrate the techniques for positioning a person in bed.

Supplies
• Bed
• Blankets
• Pillows

1. Provide for client’s privacy.
2. Communicate expectation/procedure to client (how is the client most comfortable, are there
any pressure concerns, ask about personal preferences).
3. Raise bed to comfortable position, lower side rail (if mechanical bed is available).
4. Roll client to a new preferred comfortable position (support upper torso and head).
a. Supine: flat on the back
b. Fowler’s: on the back with head raised slightly
c. Lateral: on either side (but not resting directly on hip)
d. Prone: on the stomach
5. Place pillows or soft rolled towels under such areas as:
a. The client’s head, shoulders, the small of the back
b. The arms and elbows
c. The client’s thighs (tucked under to prevent external hip rotation)
d. The ankles, calves and knees, to raise the heels off the bed. Do not just raise the ankles
without supporting the knees and calves.
6. The knees may be flexed and supported with a small pillow or blanket roll.
7. A small pillow or roll may be added at the feet to prevent foot drop.


Skills Workbook

Positioning in Bed

Supine Position, on the back, with
pillows used for support; heels off
the bed. Note pillow under head is
placed under shoulders, and under
ankles, calves and knees.

Lateral Position, on the side, with
pillows used for support-- person
should not be placed at 90 degree
angle (hip to bed) but rather
slightly side lying either to front or
to back

Wrong Right or Right

Practical Tips:
• Remember to support bony prominences to prevent pressure from bed surfaces.
• This is a good time to make skin assessments, looking for “hot spots.”
• Casual conversation with the client makes task more pleasant-for DCW and client.
• Encourage the client to help as much as they possibly can-maintaining independence.
• Replace covers for comfort; maintain privacy for the client at all times.

Don’t forget!
• Always discuss with clients their preferences and how they are most comfortable.
• Don’t forget to put the bed back down if you raised it.
• Use good body mechanics when turning and rolling. Protect your back.
• Be sure to verbalize that you need to “reposition every 2 hours or as directed.”

Practice Scenario:
Mrs. Gonzalez is 82 years old and lives by herself, with family living on the next street. She has arthritis
in both hips and does not ambulate well, but can still walk with assistance. A recent bout of pneumonia
has left her physically weaker than normal and she prefers to be out of bed for only short periods of
time. Her family and case managers are concerned about her skin integrity and possible breakdown.
They have rented an electric bed to assist in maintaining her comfort and for ease in positioning. With
encouragement and instruction, Mrs. Gonzalez can and will roll some on her own. The care plan states
to reposition Mrs. Gonzalez every 2 hours to prevent breakdown. Your shift with Mrs. Gonzalez starts
at 3 p.m. and the notes say she was positioned last at 2:30 p.m. Mrs. Gonzalez is asleep on her left side
when you arrive.

Please demonstrate the actions necessary to reposition Mrs. Gonzalez.


Skills Workbook

Body Areas Most Affected by Pressure
Body Area
1. Ear
1
8 2. Shoulder
3. Elbow
2 9
4. Hip
3 10 5. Inside knee
6. Inside heel
11 7. Outside foot
4
8. Back of head
9. Spine
5 10. Shoulder Blades
12 11. Hip
12. Tailbone
13 13. Ischium
6 14. Heel
7
14
Side-Lying Back-Lying Illustration by Lance


Skill: Assist with Positioning in Bed Comments
• Communicates with person before and during
procedure.
• Ensures client’s privacy/safety.
• Demonstrates correct procedures in rolling
client to new position.
• Demonstrates support of bony prominences.
• Demonstrates proper use of pillows for body
alignment.
• Verbalizes “Must re-position every 2 hours or
as directed.”
• The candidate is able to verbalize the listed
procedures.


Skills Workbook

Skill: Oral Hygiene
Overview
Providing proper oral hygiene for an individual that is unable to care for his or her own teeth is an
important role for a Direct Care Worker. Proper tooth brushing techniques help prevent conditions
such as gingivitis, tooth decay and tooth abrasions, a condition in which the tooth is worn away.

Competencies:
1. Provide assistance with oral care.
preferences, for example, at mealtimes.
3. Give examples of techniques that can be used to preserve dignity and privacy while providing
personal care.

Supplies:
• An extra soft or soft bristled manual toothbrush and toothpaste
• Emesis basin
• Disposable cup
• Water or mouth rinse
• Protective covering for clothing
• Protective gloves

1. Gather all needed materials.
2. Provide an explanation of what will occur prior to starting the process and continue
throughout.
3. Place the person in a seated (minimum of 60 degrees) or standing position prior to beginning.
4. Place a protective covering over the person’s clothing.
5. Wash hands and apply gloves before brushing the person’s teeth.
6. Apply water and a small amount of tooth paste to the tooth brush.
7. Brush all surfaces of the teeth and gum line before brushing the inside of the teeth. It is a
natural reaction to bite down on whatever is placed in the mouth. To help avoid the bite reflex,
do not insert the toothbrush in the inside of the mouth until later on in the process.
8. Offer the person the opportunity to rinse and spit into an emesis basin as needed. If the person
cannot independently rinse, turn the person to one side to allow the liquid to run from the
person’s mouth into a folded cloth.
9. Rinse the toothbrush periodically and apply another small amount of tooth paste as needed.
10. Clean the inside and outside teeth.
11. Upon completion, clean and dry the area around the person’s mouth and remove protective
covering. Dispose of soiled linen and trash.
12. Remove and dispose of gloves. Wash your hands.


Skills Workbook
Practical Tips:
• Try standing behind the person so you are looking down on his/her mouth. This will allow easier
access and a better view of the person’s mouth.
• Don’t use too much tooth paste.
• Brush all three areas of the teeth (outside, inside and top).
• Allow the client an opportunity to rinse as often as needed.
• If the client is not able to spit out water, use an oral swab instead of the toothbrush.

Don’t forget!
• Thoroughly clean the tooth brush after each use.
• Start with the outside of the teeth.
• Utilize standard universal precautions and infection control measures through the process.

Practice Scenarios:
Scenario 1
You are a Direct Care Worker for Juan, a 21 year old male diagnosed with Cerebral Palsy. Juan
experiences muscle tightness and involuntary movement of his arms and is unable to brush his own
teeth. Please demonstrate how you would support Juan in getting his teeth brushed.

Scenario 2
As a DCW, you work with a 12-year-old child that is medically fragile and is unable to independently sit
up. He is recovering from a recent illness and is currently unable to get out of bed. How would you
approach brushing this person’s teeth?


Skill: Oral Hygiene Comments
• Verbalizes greeting the person and providing
an explanation of what will occur prior to
starting the process and continues
throughout.
• Demonstrates ability to place a protective
covering over the persons clothing.
• Demonstrates ability to brush all surfaces of
the teeth and gum line with a gentle motion.
• Starts with the outside teeth.
• Stands behind the person.
• Verbalizes what to do if the person
o is unable to sit or is bedridden,
o cannot independently rinse his/her
mouth.


Skills Workbook

Skill: Assist with Positioning on the
Bedpan
Overview
Regular, periodic elimination of body wastes is essential for maintaining good health. Clients who are
confined to bed and who have restrictive ambulation must rely on the DCW to help them with this
task. This often includes assisting the client with the proper positioning and use of a bedpan. It is
important to understand and be able to demonstrate this skill properly. The DCW must be aware of the
emotional concerns of the client and preserve privacy and dignity in the accomplishment of this task
while maintaining good personal hygiene as well.

Competencies:
1. Give examples and techniques that preserve privacy and dignity while providing personal care.
2. Identify the characteristics of clients who may be at risk for skin integrity concerns.
3. Give examples of techniques that can be used to promote independence and respect a client’s
preferences.
4. Simulate/demonstrate the procedure for meeting toileting needs, including placing a client
on/off a bedpan.

Supplies:
• Bedpan and cover (if available) • Toilet tissue
• Basin of warm water • Soap
• Washcloth and towel • Paper towels/protective pad
• Disposable gloves • Baby powder or corn starch (if available)

1. Explain procedure/expectations to client.
2. Provide for client’s privacy.
3. Assemble supplies; place all items but protective pad on nightstand.
4. Wash hands, apply gloves.
5. Raise bed to comfortable position, lower head if elevated (if mechanical bed is used).
6. Place protective pad on bed or bedside chair.
7. Ask the individual what they need help with in removing clothing and assist as needed.
8. Fold bedcovers back, raise the client’s gown, or assist with lowering pajama bottoms.
9. Sprinkle bedpan with baby powder or cornstarch for ease in sliding on and off the bedpan
(prevents skin tears). Placing a paper towel in the bottom aides in empting solid waste and
cleaning the bedpan later.
10. If the client can assist:
a. Ask client to flex the knees and place the feet flat on the bed mattress.
b. Ask client to lift buttocks. The DCW may assist by putting a hand on the small of the
back and lifting gently and slowly with one hand.
c. Place the protective pad on the mattress. Push bedpan downward into mattress and
slide under client’s buttocks.


Skills Workbook
11. If the client cannot assist:
a. Roll client onto side, away from DCW.
b. Place the protective pad on the mattress. Push bedpan
downward into the pad and roll the client back onto
bedpan.
12. For all clients:
13. Replace the bedcovers and raise the head of the bed (if
applicable).
14. Place toilet tissue within reach.
15. Allow person privacy. Step away from the bed and ask to be
notified when through.
16. Bring tub of warm water and perineal supplies back to bedside.
17. Lower the head of the bed and remove bedpan. Unfold
bedcovers, roll client to side, pushing bedpan into the mattress
and pad and holding onto the pan carefully so as not to tip or spill contents.
18. Cover the bedpan and set aside.
19. Assist with perineal care (cleaning) as needed if client is unable to do so.
20. Assist client with hand washing or antiseptic cleanser if needed.
21. Replace clothing and bedcovers. Provide for safety and comfort.
22. Take to bedpan bathroom. Empty contents into toilet, being careful not to splash.
23. Rinse, disinfect, dry and store bedpan using proper infection control procedure.
24. Remove gloves and wash hands.
25. Communicate with client as to comfort and position as needed.

Practical Tips:
• The narrow end of the bedpan should face the foot of the bed. The client’s buttocks should rest
on the rounded shelf of the bedpan.
• Check for proper positioning to avoid spills. Glance at the bedpan from the top, between
client’s thighs.
• Always discuss preferences with the client and how they are most comfortable.
• Remember to collect supplies in advance.
• Always maintain safety and privacy in the procedure (raise/ lower bed, put up rails).
• This is a good time to make skin assessments, looking for “hot spots.”
• Encourage the client to help as much as she possibly can. This helps maintain independence.
• Stay close to hear when the client is done; don’t leave them on the bedpan too long.
• Don’t put soiled bedpan on the night stand.
• Casual conversation makes the task more pleasant for both the client and the DCW.

Don’t forget!
• Discuss the procedure with the client. Don’t just jump in and mechanically perform.
• Don’t forget your gloves!
• Be sure to keep client covered and maintain dignity throughout procedure.
• Use good body mechanics when turning and rolling – protect your back.
• Don’t forget to help the client with personal hygiene, such as washing the client’s hands.


Skills Workbook
Practice Scenario:
Mrs. Chin is 86 and recently fell and fractured her hip. It was surgically corrected with pins and rods,
but still causes her a lot of pain when she walks. The DCW’s shift with Mrs. Chin starts at 7am, to assist
her in getting up, personal care, dressing and breakfast. The first thing she wants to do every morning
is use the bedpan.

Please demonstrate how you would assist Mrs. Chin to use the bedpan, using proper techniques.


Skill: Assist with Positioning on the Bedpan Comments
procedure.
• Ensures client’s privacy/safety/dignity.
• Demonstrates correct procedures for personal
protection.
• Demonstrates proper placement of bedpan.
• Demonstrates proper personal hygiene of
client.
• Demonstrates proper bedpan removal
techniques.
• Demonstrates proper sanitation techniques.
• The applicant is able to verbalize the listed
procedures.


Skills Workbook

Skill: Assist with Bed Bath
Overview
Bathing is an activity of daily living that cleans skin, improves circulation, and provides an opportunity
for range of motion and socialization. It is preferable to transfer the client to a chair to provide a partial
bath or to a shower bench. When this is not possible due to client weakness, decreased endurance
(person cannot sit upright for an extended time), or respiratory problems that make transfers too
taxing, then a bed bath needs to be provided.

Competencies:
2. Describe/demonstrate the procedure for assisting a client with a bed bath with perineal care.
preferences.

Supplies:
• Wash basin
• Lanolin based soap (rinse-less soap works best)
• At least four soft, absorbent towels and two soft washcloths
• Disposable gloves
• Moisturizing body lotion

1. Ask the client his/her preferences. Based on the response, gather supplies and plan how to
proceed.
2. Explain procedure and continue to talk the client through each step of the bath.
3. Assist the client with removing clothing, eyeglasses, and jewelry.
4. Wash your hands and put on disposable gloves.
5. Place two large towels, one covering the shoulders to waist and the other from the waist to
the toes, on top of the client’s top sheets. Then carefully remove the top sheets
underneath, leaving the towels in place. This keeps the client covered.
6. Use one washcloth for cleansing, another for rinsing (unless a rinse-less soap is used).
7. Have the client wash his/her face if able, or wash the face making sure the areas behind the
ears get washed and dried.
8. Place towel lengthwise under the client's arm. Wash, rinse and
pat dry the arm, armpit, and hand (place the hands in the wash
basin if possible). Repeat with other arm, armpit, and hand.
9. Lift up the chest towel just enough to expose the chest and wash,
rinse and pat dry. Re-cover the chest.
10. Lift up the towel covering the abdomen and wash the area to the
groin. Rinse and pat dry. Replace the towel.
11. Remember to change the water as soon as it gets cold.


Skills Workbook

12. Place towel lengthwise under the client's leg. Wash, rinse and pat dry the leg and foot. Place
the foot in the wash basin if possible. Make sure area between the toes is dried. Check the
heels for any signs of skin problems.
13. Repeat the same process on the other side of the body.
14. Turn the client on the side away from you. Exposing just the
back, place a towel lengthwise close to back.
15. Beginning at shoulders and working down toward buttocks,
wash, rinse and pat dry the back. Examine area of tailbone for
skin problems (this is a common problem site).
16. Turn the client on back. If the person cannot wash the genital
area, do it for him or her, always wiping from genital to anal
area (front to back). (See Perineal care below.)
17. Turn client on side. Wash the rectal area, front to back, rinse and pat dry.
18. Apply moisturizer while the skin is still moist.
19. Assist the client in dressing.
20. Put away supplies, remove gloves and wash hands.

Perineal care:
Perineal care is the term for cleansing the genital area. Be sure to provide for privacy and comfort. Use
a towel of bath sheet to keep the client covered while you do perineal care.

• Female: Have the woman lie on her back with knees bent (with or
without having her knees bent depending on her ability). Visualize
the area and separate the labia. With a washcloth make one swipe
from front to back. Turn over the cloth and make another swipe from
front to back. Continue until the area is cleansed. Rinse with water
using the same procedure and pat dry.

• Male: Have the man lie on his back. If the individual is uncircumcised retract the foreskin. Grasp
the penis shaft and with a circular motion cleanse from the tip of the penis to the shaft. Turn
over the cloth and repeat from the tip of the penis down the shaft. Turn over the cloth and
repeat from tip of the penis down to the shaft. Wash the scrotum. Rinse with water and pat
dry. For the uncircumcised male put the foreskin back into the original position.

• For rectal area for both female and male: Have the person lie on the side away from you. If
necessary separate the buttocks to visualize the anal area. Wipe from the front to the back,
turning to a new area of the washcloth after each swipe until the area is clean. Rinse with water
and pat dry.

Practical Tips:
• Throughout the procedure the client should be encouraged to perform as much of the bathing
routine as possible. Ask specifically if the person can wash his/her own face or genital area.
• The DCW should ensure privacy and dignity by only exposing the areas necessary during
bathing. Close the door and pull the window shade if necessary.


Skills Workbook
• Make sure the room is warm and draft free.
• Be careful not to overtire a client. If a person becomes too tired, finish up with the most
important areas (face, hands, arm pits, and genitals) and leave the rest for another day.
• When washing the eyes, wipe one eye, turn the cloth and wipe the other so as not to
contaminate the other eye. Repeat as necessary.
• When applying moisturizer, gently massage bony prominences (e.g., hips, tailbone, elbows)
using a light circular motion. Be observant for any skin changes. Do not massage legs. Poor
circulation often causes clots to form, which can be dislodged by massage.

Don’t forget!
• Wash areas from clean to dirty, that is, from head to rectum.
• Communication is very important before and during the procedure. This includes non-verbal
communication during perineal care. If you feel uncomfortable or hesitant, your client will
probably feel the same. Even if the client is non-verbal, continue to talk to the client as if
he/she could communicate.
• Keep water warm to aid in comfort. Cool water can cause the client to catch a chill.


Skill: Assist with Bed Bath Comments
procedure.
• Demonstrates correct procedures in giving the
bed bath.
• Ensures client’s privacy.
• Demonstrates correct perineal care.
o Adequately visualizes area.
o Wipes front to back and turns cloth as
necessary.
• If requested the candidate is able to verbalize
the listed procedures.


Skills Workbook

Skill: Emptying Catheter Bag
Overview
A person with an indwelling urinary catheter will have some type of a urinary collection device, often
referred to as a catheter bag. This catheter bag will have to be emptied by the client or DCW on a
regular basis, with special attention to infection control practices.

Competencies:
1. Identify and explain the relationship between a person’s care plan and the DCW role when
providing assistance with Activities of Daily Living (ADL’s).
2. Give examples of techniques that can be used to preserve dignity and privacy while providing
personal care.
preferences.
4. Demonstrate proper procedure for emptying catheter bag.

Supplies:
• Catheter bag (large bag that can hold 2000 cc of urine, sometimes referred to as nighttime
drainage bag)
• Disposable gloves
• Collection container (can be urinal, small pitcher or comparable device)
• Optional: leg bag (holds 600-900cc and usually used during the day for more mobile clients)

1. Explain to the person what you are going to do.
2. Wash hands, put on gloves.
3. Place the drainage container below the level of the client’s bladder.
4. Unhook the tube and open the clamp over the container (be careful not to touch the tube on
the side of the container).
5. Drain the urine into the container, close the clamp, and refasten the tube to the urine bag.
6. Empty the contents of the container into the toilet. Rinse the container and pour the rinse
water into the toilet and flush.
7. Disinfect container, dry with paper towels and put away for storage.
8. Remove gloves and wash hands following proper procedure.


Skills Workbook
Practical Tips:
• Always explain to the person what is being done since the person in bed cannot see what you
are doing.
• Make sure the catheter bag tube is opened over the container because once the clamp is
opened, urine will quickly flow out.

Don’t forget!
• Never lift catheter bag or tubing above the level of the bladder. Make sure the drainage bag
and tubing ALWAYS remain below the level of the client’s bladder or else the urine could
backflow into the bladder.

Practice Scenarios:
1. Mrs. Garcia has terminal cancer. She has an indwelling catheter. Practice opening the clamp to
the drainage bag, draining the “urine” and closing the clamp. Then discuss safe disposal of body
fluids, disinfection of collection container, removing gloves and washing hands (infection
control practices).

2. Ms. Kahn has multiple sclerosis. She has an indwelling catheter and uses a nighttime urinary
collection bag and a leg bag during the day. In the morning the DCW is supposed to empty the
large catheter bag and put on a leg bag before she goes to work. The trainer will have to discuss
how to change bags using good infection control practices.


Skill: Emptying Catheter Bag Comments
• Candidate explains and communicates what is
needed throughout procedure.
• Demonstrates correct procedure when
draining the catheter bag.
o Cather bag and tubing is kept below
the level of the client’s bladder.
o Drainage tube is opened over and into
collection device.
• Verbalizes correct infection control practices
when disposing of urine and finishing with
skill.


Skills Workbook

Skill: Redirect a Person with Dementia
Overview
People with dementia will often get anxious and obsessive about events from their long term memory.
Common statements that they will make are, “I have to get home to take care of my children,” or “I
need to get home so that I can cook dinner for my husband” (even though you know the person’s
husband died several years ago). The DCW needs to redirect the person, using a calm, soothing
approach instead of arguing with the client. The redirection technique can be used to divert people’s
attention away from the stressful event to something that is more pleasant.

The DCW can also use this skill for a non-dementia client with a challenging behavior. Remember that
the client’s actions can be greatly influenced by the reaction /approach of the DCW.

Competencies:
1. Role-play or describe how to re-direct a person with dementia
2. Understand changes in behaviors and emotions

1. Use a calm, soothing voice.
2. If the client does not mind being touched, try soothing touch. Touch is powerful in conveying a
caring attitude.
3. Use short, simple sentences.
4. Do not argue about statements the person makes. Arguing can escalate the situation. The DCW
should go to the client’s reality rather than try to orient them to reality.
5. Respect people’s feelings (don’t tell them they are being stupid for how they feel, or they are
being silly, etc.). People with dementia rely on non-verbal cues and they can tell if the DCW is
being patronizing (treating them like a child).
6. Try switching to a different activity (redirection). Redirect the person to an activity that
interests him or her (remember the client’s life story). Choose activities with the abilities of the
client in mind.

Don’t forget!
• Use the calm, soothing approach and try not to get frustrated.
• The activity that the client is directed to has to be of interest to the client and not just the DCW.
• The activity must also be geared to the abilities of the client. If the activity is too hard, the client
could get frustrated. If the activity is too easy or childish, the client could get bored. Either way,
the behavior could get worse.


Skills Workbook
Practice Scenarios:
1. Mr. Allen has dementia. Every afternoon he tries to get out the door.
2. Mrs. Smith has Dementia. She is pacing and wringing her hands. She states she needs to get home to
take care of daughter who will be getting home from school. You know Mrs. Smith’s children are in
their 50s.


Skill: Redirecting a person with Comments
dementia

• Demonstrates good
communication techniques when
redirecting the client:
• Uses calm, soothing approach.
• Does not argue with client.
• Uses short, simple sentences.
• Redirects client to a suitable
activity.


Skills workbook

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Skills workbook